面部念珠菌性肉芽肿1例

报道1例面部皮肤念珠菌性肉芽肿.患者女,14岁,口角糜烂10 a,面部散在斑块、结痂6 a.表现为面部大小不等圆形暗红色斑块,表面见黄褐色厚痂.额部皮损真菌镜检见大量菌丝,真菌培养鉴定为白念珠菌.组织病理见真皮浅中层弥漫性淋巴细胞、少量中性粒细胞浸润,并见多核巨细胞.PAS染色示角质层及痂皮内见大量菌丝,真皮多核巨细胞内见孢子.诊断为念珠菌性肉芽肿.给予灰黄霉素治疗2个月、卡介菌多糖核酸治疗6个月、伊曲康唑治疗7个月后,皮损减少,面部痂皮大部分脱落,目前仍在治疗中.     

Visceral and skin granuloma annulare,diabetes, and polyendocrine disease.

A middle aged man suffered with insulin dependent diabetes, autoimmune Addison''s disease, myxoedema, and severe ulcerative colitis, for which he had undergone subtotal colectomy with formation of an ileostomy. Granuloma annulare confined to the anterior abdominal wall was diagnosed in 1981. In 1983 an episode of severe colicky pain and excessive working of the ileostomy occurred associated with severe hyperglycaemia and increased irritation of the granuloma annulare. Laparotomy disclosed adhesions and numerous white nodules over bowel, mesentery, and peritoneum histologically identical with the skin lesions. Two further episodes of subacute small bowel obstruction occurred, and a repeat laparotomy showed widespread intra-abdominal granuloma annulare. Visceral granuloma annulare appears not to have been reported before, and in this patient exacerbation of the skin lesion was associated with poor diabetic control.